Vol. 24 •Issue 20
• Page 36
The Mind-Body Connection
Guiding patients to self care and wellness
By Reji Mathew
The mind-body paradigm is a central area of inquiry, research and treatment integration. In fields such as sports psychology, mental health, medicine and wellness, there is growing analysis of the ways thoughts, feelings and behaviors impact physical health, and how physical wellbeing impacts how we think, feel and behave.
Tapping into the wealth of mind-body strategies in treatment sessions remedies a basic schism in health care—the long-time split between care for the mind and care for the body. Health and wellness require the mind and body to work together, nourishing each other for optimal functioning.
In rehabilitation, the goal of achieving functionality requires both physical and emotional energy. Patients have to engage the mind to signal the body about what to do, and a healthier body aids in developing a more resilient mind.
A mind-body perspective for rehabilitation can be formulated both as a philosophy of treatment (a therapeutic stance) or as a set of techniques. Either level offers persons with complex disabilities innumerable possibilities for exploring avenues of health and wellness.
Reconnecting
"A mind-body approach to rehabilitation moves beyond the traditional split between physical and psychological healing and adds a third component—mind-body healing," explained Matthew Sanford, yoga -instructor, founder of the Mind-Body Solutions center and author of WAKING: A Memoir of Trauma and Transcendence. "I define the mind-body connection as the intersection between mind and body."
Sanford's advocacy for mind-body philosophy comes out of his own personal trauma. During a family road trip when he was 13, an accident killed his father and sister and left Sanford with paraplegia.
After the accident, Sanford started a long process of emotional and physical recovery through rehabilitation interventions, which he felt were fragmented.
"I was taught a compensation mindset through my early rehab," he recalled. "The message I got from my doctors was to let go of the parts of my body that are lost and overcome the disability."
For years Sanford felt the daily wear and tear of navigating his mobility. A rotator cuff tear scared him into exploring ways reconnect to his lower body.
"I missed my body, I missed the lower half of me," Sanford stated. "I got tired of working against my body I just wanted to see what was possible."
He tried body work, acupressure and other alternatives. It was yoga that helped Sanford foster the mind-body connection he sought. "I developed a level of sensation in my body," he said. "I was able to direct it, enhance it, and it gave me a sense of freedom Through my yoga practice, I am now able to feel, fully in the room, and not just in a mindset of overcoming disability."
Maximizing Recovery
Sanford has reaped the benefits of his mind-body practices. "There is a level of my mind-body relationship that is not injured in the way that my physical body is injured," Sanford explained. "Discovering these subtle connections not only has helped me to feel emotionally whole. There are practical benefits also. My transfers are more graceful; I lift my tailbone; I engage my entire body; I feel I do a better job."
Through guidance, others can access that sense of awareness and connection.
Patients can experience the mind-body intersection "as a sense of 'presence' within the body," Sanford continued. "There are ways to be present in the body even when there are neurological deficits, through mindfulness, breathing and awareness. That level of sensation that can help us to be connected to our body—it is a different kind of sensation, similar to the quality of breathing, a connection to the body that is more subtle than muscular action."
Discovering this connection does not necessarily mean that someone, for example, will be able to walk again, but it leads to more important gains: an intrinsic sense of being a whole person and a connection to disconnected parts of oneself.
Sanford's organization, Mind Body Solutions, is dedicated to teaching his mind-body philosophy to both able-bodied and disabled persons. He shared a few techniques from his model, cautioning that it cannot be narrowed into a formula. They include, but are not limited to, using inward imagery as a tool, and integration of breath and movement to enhance a sense of "presence" within the mind-body system. The Courage Center, a rehabilitation facility located in Golden Valley, MN, is currently implementing Sanford's approach.
For rehabilitation professionals, Sanford reminds, "The real injury is mind-body injury. I can forge connections through my whole body that [are] not dependent on a fully functioning spinal cord."
When professionals do not help patients tap into their mind-body connections, "we are not maximizing what can be recovered," he asserted.
Mind-Body Interventions
Currently, a wide range of mind-body interventions can promote mind-body wellness. These include hypnosis, biofeedback, guided imagery, meditation, mindfulness, tai chi, diaphragmatic breathing and progressive muscle relaxation (see "Stress Management," April 28).
Mind-body modalities have two goals: First, to help patients develop awareness of the mind-body pathway—in other words, develop an understanding of how one's own mind and body interact and impact one another, establishing a connection. Second, to teach patients specific techniques for self care and/or relaxation—the "relaxation response" (coined by Herbert Benson, MD), engaging the mind to relax the body and vice versa.
It is important for practitioners to gain first-hand experience with these -strategies so they can individualize approaches for each patient. Each disability/condition presents its own challenges to achieving a relaxed state.
"I find that most of my patients have a hard time identifying their stress," shared Caroline Werner, Managing Director of CLW Solutions, a stress management firm. "An analogy I teach my patients is 'messy bed, messy head.' I model for patients that if I don't even have time to make my bed, I know that my stress is out of control.
"I present a wide range of options to patients of how they can learn to relax. Some patients are kinesthetic, others visual, and others auditory. It is important to find the right sensory mode that patient can tap into."
There are two steps to the Benson-Henry Mind-Body Institute's clinical model for eliciting the relaxation response. Step 1 involves engaging any modality (an image, word, phrase or sound) and using repetition of that cue to decrease stress arousal. Step 2 is to instruct patients to acknowledge any intrusive thoughts and then passively return to the repetition.
This method has been scientifically validated and shown to counteract the "fight or flight" stress response. It has also demonstrated positive psychological and physiological stress reduction benefits for patients with anxiety, depression, insomnia, hypertension and chronic pain.
Relaxation and Disability
While all people can benefit from these therapeutic strategies, individuals with disabilities have an even greater need for integration of the mind-body clinical framework. Persons with chronic conditions are often negotiating states of chronic stress, hyper-arousal to pain, mobility challenges and relapses.
In addition, while rehabilitation does restore patients' lives, it still requires conscious effort and exertion. Integrating mind-body techniques can alleviate some of the secondary stress of recovery and teach patients how to re-energize themselves. Teaching patients how to relax should be a standard intervention in any course of rehabilitation treatment.
John, a 35-year-old man with spina bifida, shared how learning relaxation techniques impacted him holistically.
"Learning how to relax [breathing, cognitive coping statements] is a new thing for me. I feel sad for myself that I have been consumed with anxiety for all these years. I have spina bifida, and my mobility has limited me more in the past few years. My stress was just increasing and I was feeling more depressed. Now that I know how to relax and refuel myself, I feel more hopeful that my body and my mind will last."
Clinical Strategies
Before implementing mind-body approaches with patients, it can be helpful to start with a few exploratory assessment questions. For example, ask patients or caregivers to keep a stress log for a week between sessions to gain a real-life account of the stress demands on a patient. The following questions can be a starting point:
- How does the patient relax and manage stress? (emotional)
- What are his stress thresholds for body and mind? (interactions)
- What are his functionality thresholds—under what circumstances? (physiological)
- Pay attention to thought processes: How does the patient talk to himself? (cognitive)
Peter, a 43-year-old man with multiple sclerosis, shared how exploring these questions helped him forge his own mind-body connection.
"I know the difference between my feelings and my physical sensations. I can track what comes first when I feel symptomatic. I still have the same symptoms as I did five years ago, and actually my condition has progressed in a few ways, but [because] I have mind and body skills [mindfulness, guided imagery], I know how to respond to stress in my mind and body. This helps me to feel in more control of myself. I can take care of myself and do what I can do to stay as healthy as possible. I can't emphasize enough that it is worth the effort to learn these skills."
The great strength of the field of medical rehabilitation is restoration of functional lives for a wide range of individuals with complex disabilities. Mind-body interventions enhance this mission and help patients learn essential tools for self care and wellness. n
Dr. Reji Mathew is a psychotherapist/clinical instructor at the New York University. Her clinical expertise is in integrative psychotherapy, particularly cognitive behavioral skills training. Reach her via email at rqm3463@nyu.edu.
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